FRANKEL FUNCTIONAL
REGULATOR

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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CONTENTS.
1. INTRODUCTION.
2. HISTORY.
3. SYNONYMS.
4. PHILOSOPHY.
5. INDICATIONS & CONTRAINDICATIONS.
6. ADVANTAGES & DIS...
INTRODUCTION
 Functional appliances are

defined as loose fitting or
passive appliances which
harness or eliminates
natur...
INTRODUCTION…..
The basis of functional treatment in general is the principle
that a “new pattern of function” dictated by...
INTRODUCTION….

The functional regulator is a removable orthodontic appliance
developed by Professor Rolf Frankel .
This...
HISTORY
In 1880, Kingsley introduced the term and concept

of "jumping the bite" for patients with mandibular
retrusion.
...
HISTORY
 Then Rolf Frankel of Germany developed an appliance in
about the middle of this century, which was not only
inhi...
Synonyms:

 Frankel appliance
 Vestibular appliance
 Oral gymnastic appliance
 Functional regulator

Frankel postulate...
PHILOSOPHY OF FRANKEL APPLIANCE
1.Vestibular arena of operation
Frankel appliance is confined to the oral vestibule
and ho...
Functional matrix concept of Melvin Moss:

Buccal shields of frankel directly alter the soft tissue
configuration, increa...
The functional matrix and
the Frankel appliance,
OO , Obicularis oris.
B, Buccinator. PMR,
Pterygomandibular raphe. SPC,
S...
SCREENING EFFECT OF THE BUCCAL SHIELDS

Buccal shields and lip pads effectively holds the buccal and
labial musculature aw...
2 . Sagital correction via tooth borne maxillary
anchorage
Forward posturing of the mandible is achieved by
an acrylic pad...
The vestibular shield creates
tension at the depth of the
mucobuccal fold in a lateral
direction. This tension is
directed...
5)Postural behaviour of muscles .
There is considerable evidence that
postural disorders of the orofacial musculature play...
6)Condylar growth
The anterior repositioning of the mandible
implies on alteration in the TMJ area. .Thus at right age ,
c...
INDICATIONS:
 AGE GROUP OF 8-10 YEARS (MIXED DENTITION
PERIOD)WITH GROWTH SPURTS.
SKELTAL CL II MALOCCLUSION WITH PROGNA...
CONTRAINDICATIONS
 Class I MALOCCLUSION WITH SEVERE
CROWDING
 THUMB SUCKING HABIT.
 SEVERE DENTOALVEOLAR PROBLEMS IN
PE...
ADVANTAGES:
1. It enables elimination of abnormal muscle function
thereby aiding in normal development.
2. Treatment can b...
DISADVANTAGES:
1.The appliance is bulky and the cooperation of the
patient is essential.
2.They cannot be used in adult pa...
DIAGNOSIS:
VISUAL TREATMENT OBJECTIVE DIAGNOSTIC
TEST
> The VTO for FR therapy is a simple but important
clue as to the ef...
Visual treatment objective:

Class II div I with
full occlusion

6mm of cuspal
advancement into
class I relation

www.indi...
Functional analysis.
1. Precise registration of the postural rest position
in natural head posture.
2. Path of closure fro...
Cephalometric analysis:
• Enables clinicians to identify the craniofacial
Morphogenetic pattern, direction of growth.
• Di...
TYPES OF FRANKEL APPLIANCE:
TYPES
1)FR 1
A)FR1a

USES
-------

B)FRI b ---C)FRI c ----

CL 1 AND CL 2 DIV 1 MALOCCLUSION.
...
FUNCTIONAL REGULATOR I
The FRI of Frankel has 3 modifications
a. FRI a
b. FRI b
c. FRI c
A . FRI a
uses
CL I malocclusion ...
Lingual bow:
In FR Ia a wire loop is used instead of an acrylic lingual
pad that helps in the forward position of the mand...
Palatal bow
Convexity facing distally with lateral extensions
crossing the occlusal surface in the embrasure mesial
to the...
FR I b

Uses
CL II DIV I with a deep bite and an over jet of not more
than 7mm.
Wire forming
Palatal bow 1.0mm wire is use...
Lower lingual springs
Surface of the lower incisors right above the
cingula .

Lower labial wire
It supports the Skelton f...
Palatal bow
It provides some extra wire length to facilitate a lateral
expansion adjustment.
The wire should cross the occ...
Labial bow
The bow originates in the buccal shield and lies in the
middle of the labial surfaces of incisors , turning gin...
Canine loop
The loop wraps around the lingual surface of the canines
.It is embedded in the buccal shield at the occlusal ...
Fabrication of the acrylic parts
After wires are properly adapted to the models they
are secured with sticky wax.
Shields
...
FRI c
Uses
In more severe CL II DIV 1 malocclusion in which the
overjet is more than 7mm and disto-occlusion exceeds
an en...
Component parts
The buccal shields are split horizontally and vertically into
2 parts –
Anteroinferio portion contains the...
FR II
USES
They are used for the treatment of CLII div I and II
malocclusions. They are the most widely used.
COMPONENTS
A...
CONSTRUCTION
:
The steps are
1. separators.
Recommended 1 week before taking the impression. Placed between
maxillary cani...
2. Impression
Very important clinical procedure so that impression reproduces
the whole alveolar process up to the depth o...
3.Constuction bite.

The purpose of this mandibular manipulation is to
relocate the jaw in the direction of treatment obje...
.Constuction bite………






For minor sagital problems (2-4mm) the construction bite is
taken in an end to end incisal...
Construction bite……

Frankel appliance design and construction permits a
further advancement of the mandible after a favo...
4.Working model pour up and trimming.
Models should extend away from the alveolar process at
least 5mm to permit applicati...
6. Work model mounting .
mount the models on the straight line fixators.

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7. Wax relief.
o
Wax padding under the buccal shield to establish space between
the tissue and the appliance.
o
Wax is thi...
Wire forming
The FR II is modified by adding a stainless steel
protrusion bow (0.8mm )behind the maxillary incisors ,
whic...
Canine loops

Originate in the buccal shield but they embrace the canine
buccal instead of lingually.

By placing these ...
Lingual stabilizing bow.
• Improved structural support and gives stability to the
maxillary arch.
• It originates in the v...
Fabrication of acrylic parts:

Wires are bent and properly adapted to the models and they are
secured with sticky wax .
...
FR III

USE
Treatment of CL III malocclusions.

Lip pads
Situvated in the maxillary instead of the Mandibular in
labial ve...
Labial bow.
It extends across the six mandibular anterior teeth just above the inter
dental papillae. After a 90 degree be...
Occlusal rests.
Occlusal shield originates in the vestibular shield and is adapted to
lie in the occlusal fissure of the l...
Mode of action:

The proposed method of
action of the FR-3 appliance.
The distracting forces of the
upper lip are removed ...
Construction bite
The procedure of taking the construction bite is done by retruding the
mandible as much as possible with...
Fabrication of acrylic parts same as FR I and FR II.

Finished appliance

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FR IV.

USES
•
Correction of open bite and bimaxillary protrusion.
•
exclusively confined to mixed dentition

Components.
...
MODE OF ACTION OF FR IV

As a result of treatment of these anomalies with the FR-4
appliance and lip seal training, the gr...
FR V

Modification of Frankel by Albert H Owen (1985 –JCO)

INDICATED
Long face syndrome having a high mandibular plane
an...
 The appliance consists of addition of
posterior acrylic bite blocks
to arrest molar eruption.

 It also has head gear t...
Advantages in combination of frankel with head gear.
1. The vertical dimension can be decreased through intrusion
of the m...
MODIFICATIONS
1. By H S ORTON ( JCO 1992)
> Vestibular shields have 3 -4mm less peripheral
extension than the conventional...
2. Modified function regulator
S. Haynes, Edinburgh, Great Britain
Note palatal acrylic support
and continuous buccolabial...
TREATMENT
OBJECTIVES
Frankel produces the following changes in the orofacial
complex.
1 .An Increase of sagital and transv...
1. INCREASE IN INTRA ORAL SPACE.


It is achieved primarily through buccal shields and lip
pads which eliminate the harmf...
2. VERTICAL SPACE INCREASE.


Increase of vertical intraoral space is possible because
the construction bite is taken, so...
3. MANDIBULAR PROTACTION.
The position of the mandible is changed through the
gradual training of the protractor and retra...
4. MUSCLE FUNCTION ADAPTATION.

Development of new patterns of motor function ,
improvement of muscle tones and establish...
CLINICAL HANDLING
OF THE
APPLIANCE
Stabilizing the appliance at the delivery is absolutely essential
Pre placement, all ...
Wearing time
o

Although the Frankel appliance will be worn all the time except for
the meals the treatment should be star...
SUCESSFUL TREATMENT CONSIDERATIONS.
1. PROPER IMPRESSIONS.
2. CONSTRUCTION BITE.
3. APPLIANC FABRICATION.
Patient and appl...
INSTRUCTIONS FOR THE PATIENT:
> A little discomfort is to be expected initially.
> Salivation may be increased but it shou...
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Frontal Facial Changes with the Frankel Appliance
Albert H. Owen.
ANGLE ORTHODONTICS 1988 MARCH

1. Edgewise treatment doe...
4.
Brachyfacial individuals appear to have more ideal
occlusions ( PLATOU AND ZACHRISSON (1983)28, and
perhaps have better...
Morphologic changes in the sagital dimension
using the Frankel appliance – Owen
AJO 1981 Dec
The potential improvements h...
Arch width development in Class II patients treated
with Frankel appliance
McDougall, McNamara, and Dierkes
AJO 1982 Jul
...
The results of this study indicate that expansion of the
maxillary and mandibular dental arches and their supporting
stru...
Thank you
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Frankel ortodontic appliance by thomas /certified fixed orthodontic courses by Indian dental academy

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Frankel ortodontic appliance by thomas /certified fixed orthodontic courses by Indian dental academy

  1. 1. FRANKEL FUNCTIONAL REGULATOR www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS. 1. INTRODUCTION. 2. HISTORY. 3. SYNONYMS. 4. PHILOSOPHY. 5. INDICATIONS & CONTRAINDICATIONS. 6. ADVANTAGES & DISADVANTAGES. 7. DIAGNOSIS. 8. TYPES. 9. MODIFICATION. 10.TREATMENT OBJECTIVES. 11. CLINICAL HANDLING 12.INSTRUCTIONS. 13. JOURNAL REVIEW 14.CONCLUSION. www.indiandentalacademy.com
  4. 4. INTRODUCTION  Functional appliances are defined as loose fitting or passive appliances which harness or eliminates natural forces of the orofacial musculature that are transmitted to the teeth and alveolar bone through the medium of the appliance . www.indiandentalacademy.com
  5. 5. INTRODUCTION….. The basis of functional treatment in general is the principle that a “new pattern of function” dictated by the appliance , leads to corresponding “new morphologic pattern”. www.indiandentalacademy.com
  6. 6. INTRODUCTION…. The functional regulator is a removable orthodontic appliance developed by Professor Rolf Frankel . This appliance is used during the mixed and early permanent dentition stages to effect changes in anteroposterior, transverse, and vertical jaw relationships.  The Frankel appliance, as it is more commonly termed, has two main treatment effects. First, it serves as a template against which the craniofacial muscles function. The second effect of the Frankel appliance is its influence on skeletal and dental development www.indiandentalacademy.com
  7. 7. HISTORY In 1880, Kingsley introduced the term and concept of "jumping the bite" for patients with mandibular retrusion.  Robin in 1902had created an appliance quite similar in its objectives; The monobloc. Impressed by Kingsley's concepts and appliances, Viggow Andresen in 1908 developed activator.  Frantisek Kraus of Prague used oral screen to interrupt abnormal muscle force resulting from thumb or tongue sucking . www.indiandentalacademy.com
  8. 8. HISTORY  Then Rolf Frankel of Germany developed an appliance in about the middle of this century, which was not only inhibitory but influence function in a more positive way . This initial appliance was just two buccal shields , connected by wires without any clasp . Growth guidance was a vague concept before Frankel’s contribution.  Charles Nord was correct when he called the Frankel method a, “revolution in orthodontic appliances ”. www.indiandentalacademy.com
  9. 9. Synonyms:  Frankel appliance  Vestibular appliance  Oral gymnastic appliance  Functional regulator Frankel postulates that the increase in crowding is the result of hypertonic muscles in the buccinator mechanism restricting the lateral growth of the teeth and their supporting tissues. One objective of the vestibular shield is to regulate the hypertonic muscles of the buccinator and perioral muscles, thereby giving rise to the name functional regulator. www.indiandentalacademy.com
  10. 10. PHILOSOPHY OF FRANKEL APPLIANCE 1.Vestibular arena of operation Frankel appliance is confined to the oral vestibule and holds away, The buccal and labial musculature from the dentition in those areas in which the pressure on the dento alveolar structures has restricted the outward development of these Structures. Dentition is heavily influenced by 1)Functional matrix. 2)The buccinator mechanism. 3) Orbicularis Oris complex. www.indiandentalacademy.com
  11. 11. Functional matrix concept of Melvin Moss: Buccal shields of frankel directly alter the soft tissue configuration, increasing the oral volume, that is the capsular matrix that allows the muscle to exercise and adapt and improve. The impact of the space increase on the basal development of mandible has been suggested. The term translative growth gives a new credence to the theoretic and therapeutic aspect of orthopedic treatment with frankel. www.indiandentalacademy.com
  12. 12. The functional matrix and the Frankel appliance, OO , Obicularis oris. B, Buccinator. PMR, Pterygomandibular raphe. SPC, Superior pharyngis constrictor. LP, Labial pad. VS, Vestibular shield. The functional regulator provides a larger functional matrix than the teeth. The buccinator mechanism will grow and adapt to whichever functional matrix (soft-tissue capsule) is present in the mouth. This adaptation occurs primarily during growth. After growth is complete, very little, if www.indiandentalacademy.com any, change can be expected.
  13. 13. SCREENING EFFECT OF THE BUCCAL SHIELDS Buccal shields and lip pads effectively holds the buccal and labial musculature away from the dento -alveolar complex eliminating the restrictive effect of the structures. www.indiandentalacademy.com
  14. 14. 2 . Sagital correction via tooth borne maxillary anchorage Forward posturing of the mandible is achieved by an acrylic pad that contacts alveolar bone behind the alveolar segment. 3. Differential eruption guidance. By being free of the mandibular teeth selective eruption of the lower posterior teeth is possible which corrects vertical dimension deficiencies. 4. Buccal shields , lip pads and periosteal pull. There will be an outward periosteal pull by maximum extension of the shields And pads into the depths of buccal and labial vestibule to the point at which the depth of the sulcus is under tension . www.indiandentalacademy.com
  15. 15. The vestibular shield creates tension at the depth of the mucobuccal fold in a lateral direction. This tension is directed at influencing the erupting permanent teeth to erupt further laterally than normal, thereby resulting in arch expansion. Notice that less influence is seen on fully erupted teeth, as shown by the open arrow. www.indiandentalacademy.com
  16. 16. 5)Postural behaviour of muscles . There is considerable evidence that postural disorders of the orofacial musculature play a significant role in the causation of dento facial disharmony . The aim of frankel appliance is to identify the faulty performance of orofacial musculature and to correct it by orthopedic exercises. Therefore frankel appliance is an effective muscle trainer of the orofacial musculature. www.indiandentalacademy.com
  17. 17. 6)Condylar growth The anterior repositioning of the mandible implies on alteration in the TMJ area. .Thus at right age , condylar growth can be successfully stimulated. www.indiandentalacademy.com
  18. 18. INDICATIONS:  AGE GROUP OF 8-10 YEARS (MIXED DENTITION PERIOD)WITH GROWTH SPURTS. SKELTAL CL II MALOCCLUSION WITH PROGNATHIC MAXILLA AND RETROGNATHIC MANDIBLE. FUNCTIONAL CL II MALOCCLUSION. IN A HORIZONTAL OR NETURAL GROWTH VECTOR CASE.  CL III MALOCCLUSIOS. BIMAXILLARY PROTRUSION AND OPEN BITE PROBLEMS. FUNCTIONAL RETRUSION , DEEP OVER BITE , AND EXCESSIVE INTEROCCLUSAL PROBLEMS WITH A NORMALLY POSITIONED MAXILLAE. www.indiandentalacademy.com
  19. 19. CONTRAINDICATIONS  Class I MALOCCLUSION WITH SEVERE CROWDING  THUMB SUCKING HABIT.  SEVERE DENTOALVEOLAR PROBLEMS IN PERMANENT DENTITION.  UNCOPERATIVE PATIENTS. www.indiandentalacademy.com
  20. 20. ADVANTAGES: 1. It enables elimination of abnormal muscle function thereby aiding in normal development. 2. Treatment can be initiated at early age . 3. Less chair side time is spent. 4. The frequency of the patients visit is less. 5. They do not interfere with oral hygiene status. 6. Duration of treatment is comparatively less. they deal with skeletal as well as dent alveolar problems. www.indiandentalacademy.com
  21. 21. DISADVANTAGES: 1.The appliance is bulky and the cooperation of the patient is essential. 2.They cannot be used in adult patients were the growth has ceased. 3. Cannot be used to bring about individual tooth movement and in cases of crowding. 4. Fixed appliance therapy may be required at the termination of treatment for final detailing of the treatment. www.indiandentalacademy.com
  22. 22. DIAGNOSIS: VISUAL TREATMENT OBJECTIVE DIAGNOSTIC TEST > The VTO for FR therapy is a simple but important clue as to the efficiency of the FR appliance in any clinical case . > It is a functional test , that also helps to establish whether a patient can tolerate a protrusive bite, as well as whether satisfactory esthetic improvement occurs. The patient is asked to posture the mandible forward to the correct sagital relationship. If the outcome of the VTO test is positive, the patient can be adjudged suitable for the Frankel therapy. However a proper cephalometric analysis is the correct way to determine whether FR is the appliance of choice. www.indiandentalacademy.com
  23. 23. Visual treatment objective: Class II div I with full occlusion 6mm of cuspal advancement into class I relation www.indiandentalacademy.com After VTO
  24. 24. Functional analysis. 1. Precise registration of the postural rest position in natural head posture. 2. Path of closure from postural rest to habitual occlusion. 3. Pre-maturities, point of initial contact, occlusal interferences, and resultant mandibular displacement . 4. Sounds such as clicking and crepitus in the TMJ. 5. Interocclusal clearance or freeway space. 6. Respiration . www.indiandentalacademy.com
  25. 25. Cephalometric analysis: • Enables clinicians to identify the craniofacial Morphogenetic pattern, direction of growth. • Differentiation between position and size of jaw bases. • Morphologic peculiarities. • Axial inclination & position of the maxillary and mandibular incisors www.indiandentalacademy.com
  26. 26. TYPES OF FRANKEL APPLIANCE: TYPES 1)FR 1 A)FR1a USES ------- B)FRI b ---C)FRI c ---- CL 1 AND CL 2 DIV 1 MALOCCLUSION. CL 1 MALOCCLUSION WITH MINOR CROWDING CL I WITH DEEP BITE. CL 2 DIV 1 MALOCCLUSION WITH OVERJET LESS THAN 5 mm. CL2 DIV 2 MALOCCLUSION WITH OVERJET MORE THAN 7mm. 2)FR 2 ---- CL 2 DIV 1 AND DIV 2 MALOCCLUSIONS. 3)FR3 ---- CL 3 MALOCCLUSIONS. 4) FR4 ---- OPEN BITE ANDBIMAXILLARY PROTRUSION. 5)FR 5 ---- HIGH MANDIBULAR PLANE AND VERTICAL MAXILLARY EXCESS www.indiandentalacademy.com
  27. 27. FUNCTIONAL REGULATOR I The FRI of Frankel has 3 modifications a. FRI a b. FRI b c. FRI c A . FRI a uses CL I malocclusion with mild to moderate crowding CL I deep bite cases . Components Acrylic parts 1. Vestibular shields. 2. lip pads. Wire components: 1. Palatal bow. 2. labial bow. 3.Labial support wire. 4. Lingual bow. www.indiandentalacademy.com 5. Canine loops
  28. 28. Lingual bow: In FR Ia a wire loop is used instead of an acrylic lingual pad that helps in the forward position of the mandible forward. It extends downward to the floor of the mouth which fit against the lingual tissue below the incisors. www.indiandentalacademy.com
  29. 29. Palatal bow Convexity facing distally with lateral extensions crossing the occlusal surface in the embrasure mesial to the first molar. Lip pads It eliminates the hyperactive mentalis activity. www.indiandentalacademy.com
  30. 30. FR I b Uses CL II DIV I with a deep bite and an over jet of not more than 7mm. Wire forming Palatal bow 1.0mm wire is used Tooth moving wire 0.8 mm wire is used. Component parts: Lower lingual support wire. 3 components soldered together or 1 continuous wire. Wire member follows the contours of the lingual apical base www.indiandentalacademy.com
  31. 31. Lower lingual springs Surface of the lower incisors right above the cingula . Lower labial wire It supports the Skelton for the lip pads . www.indiandentalacademy.com
  32. 32. Palatal bow It provides some extra wire length to facilitate a lateral expansion adjustment. The wire should cross the occlusal surface in the embrasure Mesial to the first molar. Locking of the appliance on the maxillary arch is mainly due to this insertion on the embrasure. www.indiandentalacademy.com
  33. 33. Labial bow The bow originates in the buccal shield and lies in the middle of the labial surfaces of incisors , turning gingivally at right angles between maxillary lateral incisors and canines. www.indiandentalacademy.com
  34. 34. Canine loop The loop wraps around the lingual surface of the canines .It is embedded in the buccal shield at the occlusal plane level. It rises sharply to the gingival margin And fits in the embrasure. www.indiandentalacademy.com
  35. 35. Fabrication of the acrylic parts After wires are properly adapted to the models they are secured with sticky wax. Shields The total thickness of the shields and pads should not be more than 2.5mm. The lingual surface of the shield should be smooth. Lip pads The upper edges of the lip pads should be at least 5mm from the gingival margin. www.indiandentalacademy.com
  36. 36. FRI c Uses In more severe CL II DIV 1 malocclusion in which the overjet is more than 7mm and disto-occlusion exceeds an end to end cusp relationship. It is seldom used. www.indiandentalacademy.com
  37. 37. Component parts The buccal shields are split horizontally and vertically into 2 parts – Anteroinferio portion contains the wires for lingual acrylic pressure pad or shield and for the lower lip pads. Vertical split is opened to the desired position by a 2 to 3 mm advancement and is then filled with acrylic. www.indiandentalacademy.com
  38. 38. FR II USES They are used for the treatment of CLII div I and II malocclusions. They are the most widely used. COMPONENTS Acrylic components a. buccal shields. b. lip pads. c. lower lingual pad. Wire components. a. palatal bow. b. labial bow. c. canine extensions. d. upper lingual wire. e. lingual cross over wire. f. support wire for lip pads. g. lower lingual springs. www.indiandentalacademy.com
  39. 39. CONSTRUCTION : The steps are 1. separators. Recommended 1 week before taking the impression. Placed between maxillary canine and first deciduous molars or first molar embrasure. The slicing mechanism allows immediate seating of the appliance. www.indiandentalacademy.com
  40. 40. 2. Impression Very important clinical procedure so that impression reproduces the whole alveolar process up to the depth of the sulci. www.indiandentalacademy.com
  41. 41. 3.Constuction bite. The purpose of this mandibular manipulation is to relocate the jaw in the direction of treatment objectives. This creates artificial functional forces and allows assessment of the appliance's mode of action. Before taking the construction bite, the clinician must prepare by making a detailed study of the plaster casts, cephalometric and pan oral head films, and the patient's functional pattern. www.indiandentalacademy.com
  42. 42. .Constuction bite………      For minor sagital problems (2-4mm) the construction bite is taken in an end to end incisal relationship. Horizontal and vertical requirements. Construction bite should not move the mandible forward further than 2.5 mm to 3mm . End to end incisal relationship or no more than 6mm forward. Positioning the edge to edge contact will determine the vertical opening. www.indiandentalacademy.com
  43. 43. Construction bite……  Frankel appliance design and construction permits a further advancement of the mandible after a favorable response to the treatment from the construction bite .  Optimal prechondroblastic activity in the condyle is observed by staged construction bite.  In the frankel technique construction bite is not open any more than needed to allow the cross over wires to pass through the interdental space. It is necessary for effective lip seal exercises www.indiandentalacademy.com
  44. 44. 4.Working model pour up and trimming. Models should extend away from the alveolar process at least 5mm to permit application of wax. 5.Cast carving. Casts are carved for accommodating the buccal shield and lip pads . www.indiandentalacademy.com
  45. 45. 6. Work model mounting . mount the models on the straight line fixators. www.indiandentalacademy.com
  46. 46. 7. Wax relief. o Wax padding under the buccal shield to establish space between the tissue and the appliance. o Wax is thicker in the maxillary sulcus than in the mandibular sulcus o Thickness is determined individually by the amount of desired expansion needed. should not exceed more than 3mm. o Wax covering important in the region of the first deciduous molar o Waxing is done separately on maxillary and mandibular cast and then joined together www.indiandentalacademy.com
  47. 47. Wire forming The FR II is modified by adding a stainless steel protrusion bow (0.8mm )behind the maxillary incisors , which serves to maintain the prefunctional alignment and also stabilizes the appliance. . www.indiandentalacademy.com
  48. 48. Canine loops  Originate in the buccal shield but they embrace the canine buccal instead of lingually.  By placing these wires 2 to 3mm away from the canine the restrictive muscle function is eliminated . www.indiandentalacademy.com
  49. 49. Lingual stabilizing bow. • Improved structural support and gives stability to the maxillary arch. • It originates in the vestibular shield and passes through the canine –first deciduous molar embrasure. • Wire forms loops that approximate the palatal mucosa and recurve vertically to contact the incisors at the canine lateral embrasure. • A 90 degree bend allows the wire to follow the lingual contours of the four incisors , right above the cingula . • Its Objective of preventing lingual tipping of the maxillary incisors. www.indiandentalacademy.com
  50. 50. Fabrication of acrylic parts:  Wires are bent and properly adapted to the models and they are secured with sticky wax .  Buccal shields and lip pads and lingual pads are fabricated in self cure acrylic. Shields:  Should extend to the vestibule.  lingual surface of the shields should be smooth. Lip pads: Upper edges of the lip pads should be at least 5mm from the gingival margin. www.indiandentalacademy.com
  51. 51. FR III USE Treatment of CL III malocclusions. Lip pads Situvated in the maxillary instead of the Mandibular in labial vestibular sulcus. It eliminates the restrictive pressure of the upper lip .To exert tension on the periosteal attachments in the depth of the maxillary sulcus, to stimulate www.indiandentalacademy.com bone growth.
  52. 52. Labial bow. It extends across the six mandibular anterior teeth just above the inter dental papillae. After a 90 degree bend downward at the distal edge of the lower canine , another horizontal bend is made approximately 5mm below the gingival margin. Buccal shields Stands away some 3mm from maxillae Posterior dento alveolar structures. They are in contact with mandibular teeth and the mandibular apical base www.indiandentalacademy.com
  53. 53. Occlusal rests. Occlusal shield originates in the vestibular shield and is adapted to lie in the occlusal fissure of the last mandibular molar. Palatal bow • It pass directly distal to the last molar tooth before inserting in the buccal shields . • It is capable of delivering a forward force vector to the maxillary dentition. www.indiandentalacademy.com
  54. 54. Mode of action: The proposed method of action of the FR-3 appliance. The distracting forces of the upper lip are removed from the maxilla by the upper labial pads. The force of the upper lip is transmitted through the appliance to the mandible because of the close fit of the appliance to that arch (after Fränkel1). www.indiandentalacademy.com
  55. 55. Construction bite The procedure of taking the construction bite is done by retruding the mandible as much as possible with the condyle in its most posterior position. The vertical opening is kept to a minimum to allow lip closure with minimal stress. Wax relief No wax is applied to the mandibular arch. www.indiandentalacademy.com
  56. 56. Fabrication of acrylic parts same as FR I and FR II. Finished appliance www.indiandentalacademy.com
  57. 57. FR IV. USES • Correction of open bite and bimaxillary protrusion. • exclusively confined to mixed dentition Components. • Same vestibular configuration as FR I and II with no canine loops and protrusion bows. • There are four occlusal rests on the maxillary first molars, and first deciduous molars to prevent tipping of the appliance. www.indiandentalacademy.com
  58. 58. MODE OF ACTION OF FR IV As a result of treatment of these anomalies with the FR-4 appliance and lip seal training, the growth and development pattern of the mandible was altered. The spontaneous downward and backward growth direction of the mandible was changed to a upward and forward direction by FR-4 therapy, allowing the skeletal anterior open bite to be successfully corrected through upward and forward mandibular rotation. www.indiandentalacademy.com
  59. 59. FR V Modification of Frankel by Albert H Owen (1985 –JCO) INDICATED Long face syndrome having a high mandibular plane angle and vertical maxillary excess . www.indiandentalacademy.com
  60. 60.  The appliance consists of addition of posterior acrylic bite blocks to arrest molar eruption.  It also has head gear tubes that accept a face bow for an occipital pull headgear. www.indiandentalacademy.com
  61. 61. Advantages in combination of frankel with head gear. 1. The vertical dimension can be decreased through intrusion of the molars. 2. Increased mandibular growth. 3. Significant lateral expansion may reduce the need for expansion. www.indiandentalacademy.com
  62. 62. MODIFICATIONS 1. By H S ORTON ( JCO 1992) > Vestibular shields have 3 -4mm less peripheral extension than the conventional appliance. Capped Frankel appliance. > Lower labial capping – The lingual acrylic of FR II is extended to cover the incisal 1/3 rd of lower incisors and cuspids. www.indiandentalacademy.com
  63. 63. 2. Modified function regulator S. Haynes, Edinburgh, Great Britain Note palatal acrylic support and continuous buccolabial acrylic construction, which replaces conventional function regulator with separate buccal shields and lip pads. The appliance is not "locked" into the mesial embrasure of the maxillary first molars by a crosspalatal bar. www.indiandentalacademy.com
  64. 64. TREATMENT OBJECTIVES Frankel produces the following changes in the orofacial complex. 1 .An Increase of sagital and transverse intraoral space. 2. An increase of vertical intra oral space. 3. Forward positioning of the mandible. 4. Muscle function adaptation. www.indiandentalacademy.com
  65. 65. 1. INCREASE IN INTRA ORAL SPACE.  It is achieved primarily through buccal shields and lip pads which eliminate the harmful mechanical forces on the pressure sensitive membraneous structures.  The constant outward pull that is exerted on the connective tissue fibers and muscle attachments in the oral vestibule is transmitted to the alveolar bone by the fibers inserting into the periostium and bone. This aids in the lateral movement. www.indiandentalacademy.com
  66. 66. 2. VERTICAL SPACE INCREASE.  Increase of vertical intraoral space is possible because the construction bite is taken, so that the bite is opened in the posterior segments as the mandible is held forward. www.indiandentalacademy.com
  67. 67. 3. MANDIBULAR PROTACTION. The position of the mandible is changed through the gradual training of the protractor and retractor muscles followed by condylar adaptation. The effect of the u loop and lingual plate on the mandibular positioning through pressure sensation . www.indiandentalacademy.com
  68. 68. 4. MUSCLE FUNCTION ADAPTATION.  Development of new patterns of motor function , improvement of muscle tones and establishment of proper oral seal.  The pads and shields massage the soft tissues improving blood circulation .  The pads and shields stretch the muscles in disto occlusion. www.indiandentalacademy.com
  69. 69. CLINICAL HANDLING OF THE APPLIANCE Stabilizing the appliance at the delivery is absolutely essential Pre placement, all margins are checked for smoothness .  Check vertical dimension.  Over extension of the labial ,lingual, lip and buccal pads causes tissue irritation . So the extension should be correct. The appliance should be inserted with a slight rotatory motion. www.indiandentalacademy.com
  70. 70. Wearing time o Although the Frankel appliance will be worn all the time except for the meals the treatment should be started slowly. o For the first two2 weeks the appliance should be worn for 2 to 4 hours during the day. o During the next 3 weeks the time is extended to 4 to 6 hours. it usually takes 2 months before the appliance is worn at night. o The appliance and treatment progress should be checked at 4 weeks interval. An initial end to end molar relationship is corrected in 6 months. Treatment timing Optimum time to start the treatment is the mixed dentition period. (8 to 10 year age) www.indiandentalacademy.com
  71. 71. SUCESSFUL TREATMENT CONSIDERATIONS. 1. PROPER IMPRESSIONS. 2. CONSTRUCTION BITE. 3. APPLIANC FABRICATION. Patient and appliance management. IMPORTANT PRECONDITIONS THAT SHOULD BE EMPHASIZED. 1. RIGHT INDICATIONS FOR TREATMENT. 2. RIGHT PSHYCOLOGICAL INTRODUCTION OF APPLIANCE 3. COPERATION OF PATIENT AND PARENTS. www.indiandentalacademy.com
  72. 72. INSTRUCTIONS FOR THE PATIENT: > A little discomfort is to be expected initially. > Salivation may be increased but it should not be a problem. > Outline the duration of wear expected. > Instruction on appliance care and oral hygiene maintenance . > Demonstrate the lip seal exercise . > Ask the patient to speak a few words and reassure that speech would normalize. > Wearing time should be correctly followed. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. Frontal Facial Changes with the Frankel Appliance Albert H. Owen. ANGLE ORTHODONTICS 1988 MARCH 1. Edgewise treatment does not appear to increase the mandibular width more than average growth without treatment. 2. Frankel treatment appears to increase the mandibular width significantly more than either Edgewise or average growth. This phenomenon is most likely due to the action of the vestibular shields. 3. Frankel treatment tends to make the patient more brachyfacial than average growth, as revealed by the frontal facial taper angle. www.indiandentalacademy.com
  75. 75. 4. Brachyfacial individuals appear to have more ideal occlusions ( PLATOU AND ZACHRISSON (1983)28, and perhaps have better stability than less brachyfacial individuals. 5. Brachyfacial faces are more common among models, movie stars, and beauty contest winners than dolichofacial faces, suggesting that brachyfacial individuals have more pleasing esthetics than more narrow-faced people. 6. Untreated Class II individuals do not appear to grow as wide as untreated Class I individuals. The reason for this is unknown. www.indiandentalacademy.com
  76. 76. Morphologic changes in the sagital dimension using the Frankel appliance – Owen AJO 1981 Dec The potential improvements have been presented, and their coordination into a multibanded practice seems possible. Whatever results are lacking after treatment with functional appliances could be perfected with fixed appliances of the clinician's choice.  The possibility of reducing the need for extractions, reducing the time needed for multibanded treatment, and improving the facial results seems to be great enough to justify further investigation of this appliance as to achieving predictable changes. www.indiandentalacademy.com
  77. 77. Arch width development in Class II patients treated with Frankel appliance McDougall, McNamara, and Dierkes AJO 1982 Jul Sixty treated and forty-seven untreated Class II, Division 1 patients were examined in this study. The patients in the former group were treated with the functional regulator of Frankel (FR-1 or FR-2), while patients in the latter group were not treated but were of similar ethnic and skeletal composition. Sequential dental casts of the treated and untreated groups were examined, and the changes in lingual, buccal, and alveolar arch widths were compared. www.indiandentalacademy.com Contd…
  78. 78. The results of this study indicate that expansion of the maxillary and mandibular dental arches and their supporting structure occurs routinely when a functional regulator (FR-1 or FR-2) is conscientiously worn by the patient. The expansion is not limited to a particular region of the dental arch, although in absolute terms the largest expansion values occur in the premolar and molar regions, while lesser values were recorded in the canine region. In addition, this study indicates that in the maxilla narrower arches tend to expand more than wider arches. www.indiandentalacademy.com
  79. 79. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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